title: Trends in hospital volume and patterns of referral for women with gynecologic cancers.
abstract: OBJECTIVE
  To estimate trends in hospital volume and referral patterns for women with uterine and ovarian cancer.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results-Medicare database was used to identify women aged 65 years or older with ovarian and uterine cancer who underwent surgery from 2000 to 2007. "Volume creep," when a greater number of patients undergo surgery at the same hospitals, and "market concentration," when a similar overall number of patients undergo a procedure but at a smaller number of hospitals, were analyzed.
  
  
  RESULTS
  Among 4,522 patients with ovarian cancer, mean hospital volume increased from 3.1 cases during 2000-2001 to 3.4 cases during 2006-2007 (P=.62) suggesting minimal volume creep. Similarly, there was little evidence of market concentration. In 2000-2001, 37.8% of women were treated at the top decile by volume hospitals compared with 41.4% in 2006-2007 (P=.14). In 2006-2007, 201 (63.2%) of the hospitals had an ovarian cancer surgery volume of two or fewer cases. Among 9,908 women with uterine cancer, the mean hospital volume increased slightly from 4.5 in 2000-2001 to 5.4 in 2006-2007 (P=.10). The percentage of patients treated at the top decile by volume of hospitals increased from 40.4% in 2000-2001 to 44.7% in 2006-2007 (P<.001). In 2006-2007, 243 (49.3%) of the hospitals had a uterine cancer surgery volume of two or fewer cases.
  
  
  CONCLUSIONS
  There have been only modest changes in the referral patterns of women with ovarian and uterine cancer. A large number of hospitals have a very low procedural volume.
authors.affiliation: Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: Yu-Shiang
authors.initials: YS
authors.lastname: Lu
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D010051:Ovarian Neoplasms / Q000601:surgery*; D012017:Referral and Consultation / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States; D014594:Uterine Neoplasms / Q000601:surgery*